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[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

Although significant advances have been made in treating malignant pediatric central nervous system tumors such as medulloblastoma, no effective therapy exists for diffuse pontine glioma or intramedullary spinal astrocytoma.

Biology of these 2 tumors is poorly understood, in part because diffuse pontine gliomas are not treated surgically, and tumor specimens from intramedullary spinal astrocytomas are rare and minuscule.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

The first case of intracranial metastases of a cervical intramedullary low-grade astrocytoma without malignant transformation in adult is presented in this report.

Seven years ago, a 45 year-old male patient underwent biopsy to confirm pathologic characteristics and received craniocervical radiation and chemotherapy for a grade II astrocytoma in the cervical spinal cord.

The tumor at the cervical and brain lesions was classified as an astrocytoma (WHO grade II).

When a patient with low-grade astrocytoma in the spinal cord has new cranial symptoms after surgery, radiaton, and chemotherapy, the possibility of its metastasis should be suspected because it can spread to the intracranial cavity even without malignant transformation as shown in this case.

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CASE REPORT: A 32 years-old man was admitted to the hospital because of a subacute spinal cord syndrome.

A new MRI with spectroscopy revealed an infiltrative lesion involving the right frontal lobe, optic chiasm, internal capsule, brainstem and cervical spinal cord, which was suggestive of low-grade astrocytoma.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

PURPOSE: To determine survival and changes in neurologic function and Karnofsky performance status (KPS) in a series of patients treated for low-grade astrocytoma of the spinal cord during the past two decades.

METHODS: This study consisted of 14 patients with pathologically confirmed low-grade astrocytoma of the spinal cord who were treated between 1980 and 2003.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

Acquired torticollis is not a diagnosis but rather a sign of an underlying disorder.

The causes of acquired torticollis include ligamentous, muscular, osseous, ocular, psychiatric, and neurologic disorders and may be a symptom of significant abnormalities of the spinal cord and brain, such as spinal syrinx or central nervous system neoplasia.

Torticollis is rarely considered to be an initial clinical presentation of posterior fossa and cervical spinal cord tumors.

We report five cases of pediatric tumors with torticollis at the onset: an astrocytoma originating from the medulla oblongata, another presumptive astrocytoma of the spinal cord located between C1 and C6 cervical vertebrae (not operated), an ependymoma located throughout the whole cervical spinal cord extending into the bulbomedullary junction, an astrocytoma originating from the bulbus and extending into the posterior fossa, and another case of a eosinophilic granuloma located extradurally through the anterior and posterior portions of the vertebral bodies from C3 to C7 producing the collapse of the sixth cervical vertebra.

All these cases reflect the misinterpretation of this neurological sign and the lack of association with the possibility of spinal or posterior fossa tumor.

This delay in the diagnosis of these diseases led to progressive neurological deterioration and to the increase in the tumor size, which made surgical intervention difficult and the prognosis unfavorable.

(1) the survival time of more than three years, which exceeded the expected survival time of ten months for a patient diagnosed with spinal cord high grade astrocytoma and (2) for the outcomes achieved through an intensive comprehensive acute inpatient interdisci-plinary rehabilitation program which helped the patient achieve previous premorbid functional goals.

[MeSH-major]Astrocytoma. Spinal Cord Neoplasms

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[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

Grossly, the bladder was large and flaccid and the cervical and lumbar spinal cord were regionally enlarged, light grey, and friable with multifocal hemorrhages.

The thoracic spinal cord was grossly normal.

Microscopically all regions of the spinal cord had similar changes, although the cervical and lumbar sections were most severely affected.

These regions were completely effaced by a moderately cellular infiltration of highly pleomorphic polygonal to spindle shaped cells, mineralization, and necrosis, which were most consistent with anaplastic astrocytoma.

The thoracic spinal cord white matter was similarly infiltrated by the neoplastic cells, with perivascular extension into the otherwise normal grey matter.

A diagnosis of anaplastic astrocytoma was confirmed using immunohistochemical stains that were positive for glial fibrillary acidic protein and S100.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

PURPOSE: To retrospectively analyze the outcome of post-operative radiotherapy for spinal cord glioma with the emphasis on the hypofractionated radiotherapy boost for dose escalation as a treatment option for high-grade spinal cordastrocytic tumors.

MATERIALS AND METHODS: Forty-one patients with spinal cord glioma received post-operative radiotherapy between 1979 and 2003.

Among 11 patients with high-grade astrocytic tumors, 5 with anaplastic astrocytoma and 1 with glioblastoma received hypofractionated radiotherapy boost for dose escalation.

RESULTS: The Kaplan-Meier survival rates at 10 years from the date of the first surgery were 64% for the entire group, 47% for the astrocytic tumors and 84% for the ependymal tumors, respectively (P=0.009).

Among 11 patients with high-grade astrocytic tumors, the actuarial survival rate at 10 years was 35%.

DISCUSSION: The results for ependymal tumors and low-grade astrocytic tumors were comparable to those reported in the literature.

Hypofractionated radiotherapy boost for dose escalation may help to prolong the survival of patients with high-grade astrocytic tumors.

Increased intracranial pressure is rarely seen in association with spinal tumors.

Open biopsy confirmed a grade 3 fibrillary astrocytoma.

The suspected mechanisms of spinal tumors causing increased intracranial pressure are reviewed as well as three other cases of spinal astrocytomas previously reported in the literature that presented with papilledema and increased intracranial pressure without hydrocephalus.

This case illustrates that increased intracranial pressure may in exceptional cases of spinal tumors precede the more typical myelopathic presentation by months and mimic idiopathic intracranial hypertension.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

Described are clinical signs and pathologic and immunohistochemical findings in an adult female raccoon (Procyon lotor) with an astrocytoma that involved medulla, cervical spinal cord, and roots of the cervical spinal nerves.

This appears to be the only reported case of astrocytoma that involved multiple anatomic sites in the central nervous system of this raccoon.

[Title]Spinal cord pilocytic astrocytoma with leptomeningeal dissemination to the brain. Case report and review of the literature.

The authors report a unique case of leptomeningeal dissemination of a spinal cord pilocytic astrocytoma (PCA) to the intracranial cerebral subarachnoid spaces in a child.

An intradural intramedullary spinal cordtumor was identified, and the lesion was subtotally resected and diagnosed by the pathology department to be a PCA.

Subsequently, the patient had recurrences of the intradural intramedullary tumor at 6 months and 2 years after his original presentation.

He underwent a repeated resection of the recurrent tumor and fenestration of an associated syrinx on both occasions.

The pathological characteristics of the reresected tumor remained consistent with those of a PCA.

The patient then underwent chemotherapy, and total spine magnetic resonance (MR) imaging 2 months later demonstrated stability in the size of the spinal cordtumor and a decrease in the associated syrinx.

However, an MR image of the head demonstrated two new areas of supratentorial subarachnoid leptomeningeal spread of the primary spinal cordtumor at the 2-month follow-up examination.

This case illustrates a unique instance of supratentorial leptomeningeal dissemination of an intramedullary spinal cord PCA in a child.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

Granular cell astrocytomas are uncommon tumors of the central nervous system (CNS) of which no cases have been documented in the spinal cord.

This variant of glioma should not be confused with benign granular cell tumor which, although rare, has been well characterized in the spinal cord.

We describe here the clinical, pathological, and radiological features of such an astrocytoma arising within the spinal cord at the dorsal level.

Magnetic resonance imaging (MRI) studies showed a 2-cm contrast-enhanced mass in the spinal cord at T6-T7, which had the appearance of an astrocytoma.

At surgery, the tumor was found to be infiltrating a posterior column with no dural attachment.

The histological diagnosis was astrocytoma with granular cell differentiation.

In addition to documenting a unique example of intramedullary granular cell astrocytoma, we review the literature to investigate differences from other tumors with granular changes described in the spinal cord.

[Publication-country] United States

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Nonenhancing tumors of the spinal cord.

In the brain, the presence or absence of gadolinium enhancement is often an indicator of tumor invasiveness and/or grade.

In the spinal cord, however, contrast enhancement has been shown in all tumor types, regardless of grade.

In this study the authors explore the incidence of nonenhancing tumors of the spinal cord and the clinical course of patients with these lesions.

METHODS: A retrospective analysis was conducted in which investigators examined the patterns of enhancement of histologically proven intramedullary spinal cord tumors that had been evaluated at the Mayo Clinic between 1998 and 2002.

Histologically, a majority of tumors were astrocytomas (eight low-grade and two high-grade lesions); one tumor was a subependymoma.

Tumors spanned from two to seven levels and were located throughout the spinal cord (four cervical, three cervicothoracic, one thoracic, and three thoracolumbar).

CONCLUSIONS: A number of intramedullary spinal cord tumors will not enhance after addition of contrast agents.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

OBJECTIVE: The aim of this study is to report on the role of neuroendoscopy during the management of hydrocephalus that led to the diagnosis of intracranial tumoral dissemination and the subsequent finding of a spinal cord glioma.

METHODS AND RESULTS: We present two children each with an intramedullary astrocytoma that presented initially with hydrocephalus without spinal cord symptoms.

The diagnosis of a cervical and a lower thoracic intramedullary tumor was made soon after on magnetic resonance imaging.

CONCLUSIONS: Spinal cord MRI with contrast should be considered initially in selected cases of hydrocephalus without evident diagnosis.

The intraoperative diagnosis of gliomatous dissemination and secondary hydrocephalus due to unrecognized spinal cord gliomas was possible, in our experience, with the routine use of the neuroendoscope.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title]Spinal seeding of a pilocytic astrocytoma in an adult, initially diagnosed 18 years previously.

Pilocytic astrocytoma (PA) is a slow-growing, well-circumscribed grade I glioma generally considered benign, with a low recurrence rate and an excellent prognosis following complete surgical resection.

Fifteen months after spinal PA resection, the patient is doing well, has regained the ability to stand independently, and has no evidence of any new or enlarging lesions.

To our knowledge, this is the longest time reported from initial tumor resection of leptomeningeal dissemination to the distal spinal cord.

[Publication-country] Netherlands

[Number-of-references] 38

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Pediatric spinal cord tumors and masses.

BACKGROUND/OBJECTIVE: Spinal cord tumors are a relatively rare diagnosis, accounting for 1% to 10% of all pediatric central nervous system tumors.

SUBJECTS: Thirty-five children with a final diagnosis of spinal cordtumor or mass, excluding dysraphism.

RESULTS: Neurodevelopmental tumors (dermoid tumors, epidermoid tumors, and teratomas) were the most common tumor type (31%), followed by astrocytomas (29%) and neuroblastomas (14%).

Mean age at diagnosis was 6.6 years (SD = 5.5 y) and did not vary significantly by tumor type except for children with neuroblastoma (mean = 0.4 y, SD = 0.5 y).

More boys (57%) were identified in the series than girls (43%); however, there was no association between tumor type and sex.

CONCLUSIONS: This study corroborates other studies indicating that intramedullary tumors are the predominant form of pediatric spinal cordtumor.

Although, in general, spinal cord tumors are relatively rare, this preliminary study supports the need to further evaluate associations between tumor type, presenting symptoms, treatment, and functional outcome in children with spinal cord tumors.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Ten years observation and treatment of multifocal pilocytic astrocytoma.

Pilocytic astrocytoma (PA) usually occurs in younger patients.

It is a benign, generally well-delineated, WHO grade I tumour with favorable prognosis, which makes it different from diffuse astrocytomas, classified as higher grades of malignancy.

A case study of PA was presented in a young female patient, observed and treated at the Neurosurgical Department for the period of 10 years, during which time she had frequent surgical procedures due to recurrence and dissemination of the tumour.

Neuroradiological study revealed cerebral tumour in the right temporal lobe, then the first temporal lobe surgery followed by re-operation and radiotherapy was performed.

After 5 years local recurrence of the tumour appeared in the right temporal region.

The patient was operated and the tumour was totally removed.

Initially, the histopathological diagnosis of ganglioglioma was suggested for primary tumour, finally the diagnosis of pilocytic astrocytoma for both recurrent and primary tumour was established.

Consecutive MRI studies revealed a spinal canal tumours localized at the thoracic level and next at sacral level.

The spinaltumour was surgically treated in both locations; the last operation was done 10 years after surgery of the primary temporal lobe tumour.

Histopathological examinations of the excised foci from spinal canal revealed neoplasm consistent with WHO grade I pilocytic astrocytoma.

The presented case indicates that despite the spread of the neoplastic process, a histopathologically benign tumour (WHO I grade) allows for long-term survival and observation period.

[Publication-country] Poland

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] [Imaging of demyelinating and neoplastic diseases of the spinal cord].

Demyelinating as well as neoplastic spinal cord diseases can cause paresthesia, progressive sensomotoric deficits and bowel and bladder dysfunction.

Although intramedullary neoplasms are far less common than demyelinating spinal cord diseases, radiologists should be familiar with the three most common entities, astrocytoma, ependymoma and hemangioblastoma, which represent over 70% of all spinal cord neoplasms.

An early diagnosis and therapy is essential with neoplastic and demyelinating spinal cord diseases to hold residual neurological deficits as low as possible.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Enlargement of the spinal cord: inflammation or neoplasm?

Intramedullary spinal tumours are uncommon lesions that can cause significant difficulties in the differential diagnosis between inflammatory diseases such as multiple sclerosis and acute disseminated encephalomyelitis, and vascular malformations or neoplasms.

We report five cases in which the history and the clinical symptoms suggested an inflammatory process of the spinal cord but the MRI characteristics were those of neoplastic lesions.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

Although there has been considerable experience with anterior approaches to ventral intradural, extramedullary, and pial-based spinal lesions, there is no information in the literature regarding the safety and feasibility of the resection of an intramedullary tumor via an anterior approach.

The authors report on the gross-total resection of an intramedullary cervical pilocytic astrocytoma via a C-7 corpectomy and anterior myelotomy.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Irradiation of pediatric high-grade spinal cord tumors.

METHODS AND MATERIALS: A retrospective chart review was conducted that included 17 children with high-grade spinal cord tumors treated with RT at St. Jude Children's Research Hospital between 1981 and 2007.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

BACKGROUND AND PURPOSE: We retrospectively evaluated the therapeutic outcomes of patients with primary spinal cord astrocytomas treated with conventional radiotherapy at our institute.

PATIENTS AND METHODS: Between May 1975 and December 1997, 26 patients with histologically proven spinal cord astrocytomas were treated with conventional radiotherapy, and twenty-four eligible patients were evaluated.

Patients were treated with 1-2 Gy daily fractions, and given to a median total dose of 49.5 Gy (range 35-60 Gy) external radiotherapy to primary tumor.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Surgical outcomes of spinal cord astrocytomas.

Impacts of the tumor histological grade, the level of the tumor, the types of surgical interventions, and the use of adjuvant radiotherapies on the survival and functional outcomes of 30 patients (18 in low-grade and 12 high-grade malignancy tumors) were analyzed.

CONCLUSIONS: The tumor grade and the extent of tumor resection were significant prognostic factors for survival rate.

[MeSH-major]Astrocytoma / surgery. Spinal Cord Neoplasms / surgery

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To clarify these issues, the authors performed a regional population-based study of spinal cord LGGs in pediatric patients.

Epidemiological and clinical data in this cohort were different than in patients with other spinal tumors and strikingly similar to data from pediatric patients with intracranial LGGs.

Histological testing revealed a Grade I astrocytoma in 86% of tumors.

Chemotherapy and radiation therapy showed similar efficacy, achieving sustained tumor control in most patients.

CONCLUSIONS: This study provides basic data on the incidence, clinical course, and outcome of spinal cord LGGs in pediatric patients.

The similarities between spinal and intracranial LGGs in pediatric patients showing excellent survival but high morbidity suggest that a less aggressive approach may be the preferable treatment option for these patients.

Sequence analysis of tumor protein 53 gene (TP53) revealed a missense mutation in exon 5, and expression of phosphatase and tensin homolog (mutated in multiple advanced cancers 1) (PTEN) protein was not detected, which may have contributed to astrocytoma development.

To our knowledge, this is the first definitive case of pilocytic astrocytoma presenting as PDLG.

The optimum treatment of those tumors is controversial, with the recent advance, the operation of IMSCTs has became safer and total resection of most those tumor is possible.

METHODS: Data from 174 IMSCTs operated on in the last 20 years are analyzed retrospectively by the tumors' anatomic locations, histologic types, symptoms and signs, tumor removal rate, and operative outcomes.

RESULTS: In this group ependymoma was the commonest tumor (48.9%), the second most often seen being astrocytoma (35.6%).

Total resection of the tumor was possible in 60.9% of patients, subtotal resection in 17.2%, and partial resection in 13.8%.

In low grade astrocytoma total resection was possible in 41.1%, subtotal in 35.1%, and partial resection in 23.2%.

On long-term follow-up there was improvement in 70.2%, no change in 19.5%, deterioration in 4%, tumor recurrence in 6.9%, with 6.3% of patients dying.

CONCLUSION: Most intramedullary spinal cord tumors need operative treatment as early as possible.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

Spinal cord astrocytomas are rare neoplasms that can result in alteration of the spinal cord structural integrity, which can be assessed by using diffusion tensor imaging methods.

Our objective was to visualize the deformation of the posterior spinal cord lemniscal and corticospinal tracts in 5 patients with low-grade astrocytomas compared with 10 healthy volunteers by using 3D fiber-tracking reconstructions.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Lumbosacral glioblastoma and leptomeningeal gliomatosis complicating the course of a cervicothoracic astrocytoma WHO grade II.

CASE REPORT: The reported female patient underwent sub-total resection of an intra-medullary cervicothoracic astrocytoma classified as WHO grade II in 1984 at the age of 18 months and received local irradiation.

Sixteen years later, a small recurrent cervicothoracic tumour was found and spinal seeding to the equine nerve roots and the left cerebellar cortex was apparent on MRI.

The patient was implanted with a ventriculoperitoneal shunt for a pseudo-tumour cerebri producing papilloedema, which eventually lead to amaurosis.

After an extended biopsy, the invasive lumbosacral tumour was classified as glioblastoma multiforme.

DISCUSSION AND CONCLUSION: Anaplastic progression and dissemination of spinal astrocytomas even two decades after initial diagnosis and treatment are rare.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

OBJECTIVE AND IMPORTANCE: Surgery for excision of intramedullary spinal cord tumors without increasing neurological deficit is one of the more difficult operations in spinal surgery.

In particular, infiltrating astrocytomas without a clear cleavage between the tumor and normal spinal cord parenchyma are difficult to remove totally without producing additional neurological impairment.

CLINICAL PRESENTATION: Three cases of spinal cord astrocytomas were treated using a two-staged method.

A thin expanded polytetrafluoroethylene sheet was placed between the dorsal surface of the spinal cord and dura mater to prevent adhesions.

Two or 3 weeks after surgery, a second surgery was performed to remove the now exophytic tumor.

RESULTS: Magnetic resonance imaging scans showed exophytic extrusion of the tumor in all three cases before the second operation.

All three patients remain neurologically stable without evidence of tumor recurrence more than 3 years after surgery.

CONCLUSION: A two-stage operation may enhance the surgeon's ability to completely resect extensive low-grade spinal cord astrocytomas and, at the same time preserve neurological function.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

PURPOSE: To determine the impact of postoperative radiation therapy (POXRT) on outcome in spinal cord gliomas.

PFS in ependymoma patients was 74%, 60%, and 35% at 5, 10, 15 years, respectively, and was significantly influenced by treatment type, race, age, tumor grade, and type of surgery on univariate analysis, with age being the only significant factor on multivariate analysis (MVA) (p = 0.01).

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

Magnetic resonance imaging is the current imaging modality of choice in the evaluation of patients presenting with myelopathic symptoms in the search for spinal cord lesions.

It is important for the radiologist to recognize and differentiate nonneoplastic from the neoplastic process of the spinal cord as the differentiation of the 2 entities is extremely crucial to the neurosurgeon.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

We aimed to prospectively analyze correlations between clinical features and histological classification of multi-segment intramedullary spinal cord tumors (MSICTs), and the extent of microsurgical resection and functional outcomes.

Fifty-six patients with MSICTs underwent microsurgery for tumor removal using a posterior approach.

The tumor was exposed through a dorsal myelotomy.

Correlation analyses were performed between functional outcome (IJOA score) and histological features, age, tumor location, and the longitudinal extent of spinal cord involvement.

Ependymoma was the most frequent MSICT type, seen in 22 of 56 patients (39%), followed by low grade astrocytoma (17 patients, 30%) and glioblastoma multiforme (3 patients, 5%).

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Pilomyxoid astrocytoma in unusual location in a child with neurofibromatosis type 1: case report and review of the literature.

Pilomyxoid astrocytoma (PMA) is a recently defined brain tumor believed to be a variant of pilocytic astrocytoma (PA), but with a more aggressive course.

Most PMAs occur in the optic-chiasmatic/hypothalamic (OCH) region but they have also been described in the posterior fossa, temporal lobe, and in the spinal cord.

Despite the fact that most of PMAs occur in the hypothalamic region, high awareness should be given to lesions in unusual locations, thus expanding the current epidemiologically known locations for this tumor.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

OBJECT: Intramedullary spinal cord tumors (IMSCTs) in the older-age adult population pose complex management issues regarding the extent of resection and functional outcome, especially in terms of quality of life.

Ependymoma was the most common tumor (83%), and 55% were located in the thoracic spine.

There were two deaths due tumor progression (both malignant tumors) and one recurrence (anaplastic astrocytoma).

[Other-IDs] NLM/ PMC1828108

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Intradural extramedullary spinal spread of oligoastrocytoma.

Spinal involvement from supratentorial oligoastrocytoma is rare, with only five previous case reports.

We report a patient with a past history of a frontal oligoastrocytoma who presented 26 months post-primary resection with posterior fossa disease and spinal extension, in the absence of local recurrence or malignant transformation.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

OBJECTIVE: To analyze factors with impact on the functional outcome for patients with surgically treated intramedullary spinal cord tumors (IMSCT) and to point out characteristics of the different histological entities.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases.

OBJECTIVE: To review a series of patients who underwent surgical removal of intramedullary spinal cord tumors, focusing on the long-term functional outcome, recurrence rates for the various tumors, and technical problems continually debated in neurosurgical practice.

Lesions were located in the cervical spinal cord in 61 patients (30%), at a dorsal site in 60 (29%), at a cervicodorsal site in 51 (25%), and in the medullary cone in 30 (15%).

CONCLUSION: Determinant predictors of a good outcome after surgery for intramedullary spinal cord tumors are histological type of lesion, complete removal of the lesion, and a satisfactory neurological status before surgery.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

In this report we present an unusual case of severe emaciation in a 4(9)/(12)-year-old girl with a juvenile pilocytic astrocytoma of the hypothalamic region and brain stem with neuroaxis dissemination.

This case illustrates the importance of considering intracranial mass-lesions in the differential diagnosis of weight loss, psychological disturbance and atypical eating disorder.

We discuss the importance of tumor multifocality and the role of patient age in the clinical presentation with reference to the literature.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] [Spinal pleomorphic xantoastrocytoma. Case report].

INTRODUCTION: we report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma, an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature.

The differential imagine diagnosis was established between intramedullary astrocytoma and ependimoma.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

OBJECTIVE: Spinal cord hamartomas are a rare occurrence characterized by well- differentiated mature elements located in an irregular position in the spinal cord.

CLINICAL PRESENTATION: The authors present the unique case of a 12-year-old boy who originally presented to our center for treatment of a right thalamic astrocytoma.

Spinal magnetic resonance imaging performed at this time revealed an intramedullary spinal cord lesion from T4 to T8, which was later found to be composed of hamartomatous tissue.

CONCLUSION: Although typically described in the literature as spinal cord hamartomas because of their histological composition, these rare hamartomatous lesions may be the result of a neurulation defect rather than true hamartomas.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Intramedullary clear cell ependymoma in the thoracic spinal cord: a case with its crush smear and ultrastructural findings.

Clear cell ependymoma was included in the World Health Organization classification of the nervous system in 1993, and all the reported cases, except for two in the spinal cord, were located in the brain, mainly in the supratentorial compartment.

Astrocytomas outnumber ependymomas in the spinal cord, and the two entities partly share cytologic findings such as long, bipolar glial processes and oval to round nuclei resembling those seen in pilocytic astrocytoma.

Here, we report the first Korean case of intramedullary clear cell ependymoma of the spinal cord, which is the third case situated in the spinal cord in the literature.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

INTRODUCTION: The optimal time point for surgery of intramedullary spinal astrocytomas and ependymomas is often debated on, as predicting factors are poorly defined.

Complete tumor resection was achieved in 79% of ependymomas, 50% of astrocytomas WHO grade I, and 14% of astrocytomas WHO grade II (significantly more often in ependymomas than in astrocytomas, p < 0.05).

Preoperative MCS <3 and extent of tumor <5 levels were significantly (p = 0.01 and p < 0.05) associated with a favorable outcome (MCS <3) in early and late follow-up.

CONCLUSION: An MCS of less than 3 and a tumor extent of less than 5 levels are the most important factors for a favorable postoperative functional outcome.

A fusiform enlargement of the cord extending from T5 to T8 was shown.

The space occupying lesion infiltrated diffusely the spinal cord.

Biopsies were taken from different exophytic tumor areas whereas the intramedullary part was spared.

The histologic examination confirmed the typical pattern of a pilocytic astrocytoma in all specimens.

In our surgical experience with 226 intramedullary tumors and with 117 patients affected by intracranial pilocytic astrocytoma this case is unique because of its combination of tumor location, growth pattern and age of the patient.

[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Paraplegia due to spinal subdural hematoma as a complication of posterior fossa surgery: Case report and review of the literature.

Although blood contamination of cerebrospinal fluid (CSF) after an intracranial operation is possible, development of a symptomatic spinal hematoma after a posterior fossa surgery has never been reported.

A 43-year-old woman underwent a posterior fossa tumor removal in the prone position with no intraoperative difficulty.

On the second postoperative day, she complained of severe epigastric pain and developed a rapid onset of paraplegia with anesthesia below the thoracic 5 spinal level.

The emergency cranial and spinal MRIs revealed a spinal extramedullary hemorrhage spreading to the whole spinal regions, just sparing the cauda equina area.

There was a prominent localized hematoma formation surrounding and compressing the spinal cord at the upper thoracic levels, which was evacuated via an urgent laminectomy.

Development of the spinal hematoma was explained by the movement of blood from the tumor bed into the spinal canal under the effect of gravity, during or after the operation.

We conclusively suggest that a spinal hematoma should be taken into consideration as a rare but potentially severe complication of a posterior fossa surgery.

Meticulous hemostasis and isolation of the surgical area from the spinal spaces are essential.

Postoperatively, patients should be monitored for spinal findings as well as cranial signs.